Drugs Requiring Prior Authorization

Certain medications require prior authorization. Your pharmacist will help you arrange for these drugs. Physicians must call Express Scripts.

Express Scripts

(800) 753-2851 — Physicians only

Oncology Treatment: Call eviCore at (888) 910-1199

Express Scripts’ prior authorization (PA) policies include the brand medication and any available generics for that brand.

Benefit Fund

(646) 473-7446

Drug Classes Requiring Approval by Benefit Fund

  • Factor VIII blood factor products
  • Rare diseases (e.g. Fabry’s Disease, Gaucher’s Disease)

Click here for a complete list.

Subject to Change

Drugs Requiring Prior Authorization Effective January 2017

Drug TargetTherapy Class
AbstralPain - Narcotic
AccolateAsthma/COPD
Actemra IVInflammatory Conditions
Actemra SCInflammatory Conditions
ActiqPain - Narcotic
AdcircaPulmonary Hypertension
Adderall XRAttention Disorders
AdempasPulmonary Hypertension
AdipexWeight Loss
amphetamine sulfateAttention Disorders
AmpyraMultiple Sclerosis
anabolic steroidHormone Supplementation
AndrodermEndocrine Disorder
AndroGelEndocrine Disorder
Aptensio XRAttention Disorders
Aralast NPMetabolic, Immune Disorders or Inherited Rare Disease
AranespBlood Cell Deficiency
ArcalystMetabolic, Immune Disorders or Inherited Rare Disease
Atralin gelSkin Conditions
AubagioMultiple Sclerosis
AveedEndocrine Disorder
AvitaSkin Conditions
AvonexMultiple Sclerosis
AxironEndocrine Disorder
BelviqWeight Loss
BenlystaMetabolic, Immune Disorders or Inherited Rare Disease
BerinertMetabolic, Immune Disorders or Inherited Rare Disease
Betaseron, ExtaviaMultiple Sclerosis
BivigamMetabolic, Immune Disorders or Inherited Rare Disease
BontrilWeight Loss
BotoxNeurological Disorders
Brand SingulairAsthma/COPD
BunavailPain - Narcotic
ButransPain - Narcotic
BydureonDiabetes
ByettaDiabetes
CarimuneMetabolic, Immune Disorders or Inherited Rare Disease
CaverjectImpotence
Caverject ImpluseImpotence
CaystonAnti-infectives
ChenodalMetabolic, Immune Disorders or Inherited Rare Disease
CholbamMetabolic, Immune Disorders or Inherited Rare Disease
CimziaInflammatory Conditions
CinqairAsthma Specialty
CinryzeMetabolic, Immune Disorders or Inherited Rare Disease
ConcertaAttention Disorders
ContraveWeight Loss
CopaxoneMultiple Sclerosis
CopegusHepatitis C
CosentyxInflammatory Conditions
DaklinzaHepatitis C
DalirespBlood Cell Deficiency
DaytranaAttention Disorders
DelatestrylEndocrine Disorder
Depo - TestosteroneEndocrine Disorder
DesoxynAttention Disorders
Dexedrine SpansulesAttention Disorders
dexmethylphenidate HCLAttention Disorders
dextroamphetamine sulfateAttention Disorders
dextroamphetamine sulfate tabletsAttention Disorders
diclofenac sodiumSkin Conditions
DidrexWeight Loss
DificidAnti-Infectives
Dyanavel XRAttention Disorders
DysportNeurological Disorders
EdexImpotence
EgriftaEndocrine Disorder
EligardEndocrine Disorder
EnbrelInflammatory Conditions
EntrestoHeart Failure
EntyvioInflammatory Conditions
EpclusaHepatitis C
EpogenBlood Cell Deficiency
epoprostenol sodiumPulmonary Hypertension
EsbrietRespiratory Miscellaneous
EuflexxaOsteoarthritis
EvekeoAttention Disorders
EyleaEye Conditions
Fabior 0.1% foamSkin Conditions
fentanylPain - Narcotic
FentoraPain - Narcotic
FerriproxMetabolic, Immune Disorders or Inherited Rare Disease
FirazyrMetabolic, Immune Disorders or Inherited Rare Disease
First - TestosteroneEndocrine Disorder
First - Testosterone MCEndocrine Disorder
Flebogamma DIFMetabolic, Immune Disorders or Inherited Rare Disease
FlolanPulmonary Hypertension
FocalinAttention Disorders
Focalin XRAttention Disorders
ForteoBone Conditions
FortestaEndocrine Disorder
GabitrilNeurological Disorders
GammagardMetabolic, Immune Disorders or Inherited Rare Disease
Gammagard LiquidMetabolic, Immune Disorders or Inherited Rare Disease
Gammagard S/DMetabolic, Immune Disorders or Inherited Rare Disease
GammakedMetabolic, Immune Disorders or Inherited Rare Disease
GammaplexMetabolic, Immune Disorders or Inherited Rare Disease
GamunexMetabolic, Immune Disorders or Inherited Rare Disease
Gamunex-CMetabolic, Immune Disorders or Inherited Rare Disease
Gel-OneOsteoarthritis
GenotropinEndocrine Disorder
GilenyaMultiple Sclerosis
GlassiaMetabolic, Immune Disorders or Inherited Rare Disease
GlatopaMultiple Sclerosis
GranixBlood Cell Deficiency
GrastekAllergies
H.P. Acthar GelMetabolic, Immune Disorders or Inherited Rare Disease
HarvoniHepatitis C
HetliozSleep Disorder
HizentraMetabolic, Immune Disorders or Inherited Rare Disease
HumatropeEndocrine Disorder
HumiraInflammatory Conditions
HyalganOsteoarthritis
HymovisOsteoarthritis
HyqviaMetabolic, Immune Disorders or Inherited Rare Disease
ibandronate sodiumBone Conditions
IlarisMetabolic, Immune Disorders or Inherited Rare Disease
IncrelexEndocrine Disorder
InflectraInflammatory Conditions
KalbitorMetabolic, Immune Disorders or Inherited Rare Disease
KalydecoRespiratory Miscellaneous
KeveyisMetabolic, Immune Disorders or Inherited Rare Disease
KineretInflammatory Conditions
KorlymEndocrine Disorder
KrystexxaGout
KuvanMetabolic, Immune Disorders or Inherited Rare Disease
LazandaPain - Narcotic
LemtradaAsthma/COPD
LetairisPulmonary Hypertension
lidocainePain
lisdexamfetamine dimAttention Disorders
LovazaHigh Blood Cholesterol
LucentisEye Conditions
LupanetaEndocrine Disorder
Lupron DepotEndocrine Disorder
Lupron Depot-PedEndocrine Disorder
MacugenEye Conditions
MakenaHormone Supplementation
Metadate CDAttention Disorders
Metadate ERAttention Disorders
MethylinAttention Disorders
methylphenidateAttention Disorders
methylphenidate ERAttention Disorders
methylphenidate HCLAttention Disorders
MirceraBlood Cell Deficiency
modafinilNarcolepsy
ModeribaHepatitis C
MonoviscOsteoarthritis
MuseImpotence
MyaleptEndocrine Disorder
MyoblocNeurological Disorders
NatparaEndocrine Disorder
NeulastaBlood Cell Deficiency
NeupogenBlood Cell Deficiency
NorditropinEndocrine Disorder
NortheraNeurological Disorders
NplateMetabolic, Immune Disorders or Inherited Rare Disease
NucalaAsthma Specialty
NuedextaNeurological Disorders
NutropinEndocrine Disorder
Nutropin AQEndocrine Disorder
NuvigilNarcolepsy
OcalivaMetabolic, Immune Disorders or Inherited Rare Disease
OctagamMetabolic, Immune Disorders or Inherited Rare Disease
OfevRespiratory Miscellaneous
OlysioHepatitis C
OmnitropeEndocrine Disorder
OnsolisPain - Narcotic
OpsumitPulmonary Hypertension
OralairAllergies
OrenciaInflammatory Conditions
OrenitramPulmonary Hypertension
OrkambiRespiratory Miscellaneous
OrthoviscOsteoarthritis
OtezlaInflammatory Conditions
PegasysHepatitis C
PegIntronHepatitis C
PlegridyMultiple Sclerosis
PraluentHigh Blood Cholesterol
PrivigenMetabolic, Immune Disorders or Inherited Rare Disease
ProcentraAttention Disorders
ProcritBlood Cell Deficiency
ProlastinMetabolic, Immune Disorders or Inherited Rare Disease
Prolastin CMetabolic, Immune Disorders or Inherited Rare Disease
ProliaBone Conditions
PromactaMetabolic, Immune Disorders or Inherited Rare Disease
QsymiaWeight Loss
Quillichew ERAttention Disorders
Quillivant XRAttention Disorders
RagwitekAllergies
RebetolHepatitis C
RebifMultiple Sclerosis
RelistorPain - Narcotic
RemicadeInflammatory Conditions
RemodulinPulmonary Hypertension
RepathaHigh Blood Cholesterol
RestasisEye Conditions
Retin-ASkin Conditions
Retin-A MicroSkin Conditions
RevatioPulmonary Hypertension
RibasphereHepatitis C
RitalinAttention Disorders
Ritalin LAAttention Disorders
Ritalin SRAttention Disorders
RituxanInflammatory Conditions
RuconestMetabolic, Immune Disorders or Inherited Rare Disease
SaizenEndocrine Disorder
SaxendaWeight Loss
SelzentryHIV
SensiparEndocrine Disorder
SerostimEndocrine Disorder
Signifor/Signifor LAREndocrine Disorder
SimponiInflammatory Conditions
SovaldiHepatitis C
StelaraInflammatory Conditions
StriantEndocrine Disorder
SuboxonePain - Narcotic
SubsysPain - Narcotic
SupartzOsteoarthritis
SuprenzaWeight Loss
SymlinDiabetes
SynagisRespiratory Miscellaneous
SynviscOsteoarthritis
Synvisc-OneOsteoarthritis
SyprineMetabolic, Immune Disorders or Inherited Rare Disease
TaltzInflammatory Conditions
TanzeumDiabetes
Tazorac 0.05% and 0.1% cream, gel Skin Conditions
TecfideraMultiple Sclerosis
TechnivieHepatitis C
TenuateWeight Loss
TestimEndocrine Disorder
TestopelEndocrine Disorder
tetrabenazineNeurological Disorders
topiramateNeurological Disorders
TracleerPulmonary Hypertension
tretinoin topical productsSkin Conditions
Tretin XSkin Conditions
TrulicityDiabetes
TysabriMultiple Sclerosis
TyvasoPulmonary Hypertension
UptraviPulmonary Hypertension
VascepaHigh Blood Cholesterol
VeltinSkin Conditions
VentavisPulmonary Hypertension
VictozaDiabetes
ViekiraHepatitis C
VprivMetabolic, Immune Disorders or Inherited Rare Disease
VyvanseAttention Disorders
XeljanzInflammatory Conditions
Xeljanz XRInflammatory Conditions
XenicalWeight Loss
XeominNeurological Disorders
XiidraEye Conditions
XolairAsthma Specialty
ZarxioBlood Cell Deficiency
ZavescaMetabolic, Immune Disorders or Inherited Rare Disease
ZemairaMetabolic, Immune Disorders or Inherited Rare Disease
ZenzediAttention Disorders
ZepatierHepatitis C
ZianaSkin Conditions
ZinbrytaMultiple Sclerosis
zoledronic acid/mannitol & waterBone Conditions
ZomactonEndocrine Disorder
ZorbtiveEndocrine Disorder
ZubsolvPain - Narcotic
ZyfloAsthma/COPD
Zyflo CRAsthma/COPD